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Here’s how 2 former Googlers convinced Johnson & Johnson to bet on the hottest part of healthcare and raised $47 million in the process


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Thirty Madison cofounders Demetri Karagas and Steven Gutentag.

Courtesy Keeps


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  • Thirty Madison in August raised $47 million from investors including Johnson & Johnson Innovation.
  • The 2-year-old startup treats conditions like migraines with three distinct companies: Cove, Evens, and Keeps.
  • Like a handful of other chronic-care direct-to-consumer companies, Thirty Madison’s business has accelerated because of the pandemic but also because of deep-seated issues in the US healthcare system.
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In the past year, Thirty Madison, a startup that prescribes medicine and does online doctor’s visits, nabbed a partnership with Eli Lilly and grew its subscriber base by threefold.

In August, the startup raised $47 million from the venture firms Johnson & Johnson Innovation, Polaris Partners, Maveron, and Northzone, bringing the startup’s total funding to $70 million. 

Thirty Madison treats 250,000 active patients with migraines, acid reflux, and hair loss with companies called Cove, Evens, and Keeps, respectively. It’s rolling the new funds into a fourth treatment area, cofounder and CEO Steven Gutentag told Business Insider, declining to say which.

Similar to the healthcare startups Ro, Hims, Livongo, and Omada, Thirty Madison’s business has been helped by the recent move to telemedicine during the coronavirus pandemic. It’ll pass 100 employees in November after doubling its team since March, according to the company. But it’s also riding another wave, which is a deeper issue in healthcare, Gutentag said: Not enough people have consistent relationships with primary-care physicians. 

A run-in with hair loss kicked off the idea for a startup that prescribes and ships medications to your door

Gutentag and cofounder Demetri Karagas started the company in 2017 after working for Google’s ads group for the search page. Neither of them had healthcare experience other than as patients and sons of doctors, but Gutentag’s run-in with hair loss gave the pair an idea, he said.

“I’ve had Crohn’s my whole life, or almost my whole life. Funny enough, that was not the issue that did it,” Gutentag said. “It was more the vain health issue of hair loss that got me to wake up.” 

For the first time, he said, he found himself having to navigate the healthcare system alone. 

Thirty Madison’s goal is basically to spare patients the issue of “navigation” altogether by giving them treatment plans and long-term relationships with specialists. The startup is based in midtown Manhattan and named after Madison Avenue.

It offers memberships for about $30 per month and messaging with doctors for up to $5 per month or $5 per visit, depending on the condition. Treatment costs, like a $25-per-month hair-loss pill called finasteride, aren’t included in the membership, and they’re generally self-pay. 

The hope is to connect patients with an otherwise strained supply of specialists for conditions like migraines, Gutentag said. There are about 40 million people in the US who suffer from migraines but fewer than 500 specialists, according to the Migraine Research Foundation.

More than 60% of Thirty Madison’s migraine patients have nine or more migraines per month, Gutentag said. As of August, 70% of them were seeing reductions in their severity, and 79% were visiting the emergency room less, the company said in its funding announcement.

How Thirty Madison convinced a pharma giant to invest in its model

Gutentag sees the model heading more toward Teladoc and Livongo’s soon-to-be massive primary-care network than Ro and Hims. In the recent funding round, he said investors, particularly Polaris and J&J, wanted in when they realized the company was building models of care delivery, not just consumer brands for drugs.

The startup’s physicians are employed or contracted by KMG Medical Group, and it sends drugs through the mail, with pharmacies licensed in all 50 states, including Amazon’s PillPack. It makes up a closed system for each condition that allows patients to get advice, treatment, and face time with physicians all from the same platform, the cofounder said.

“That’s why you’re seeing the rise of solutions that help patients beyond just one part of the health issue,” Gutentag said. “It’s not just about me being a better doctor’s office or a better pharmacy. It’s about actually helping someone drive to a better outcome over a longer period of time.” 

Here’s the pitch deck that won Thirty Madison $47 million and backing from J&J. One slide about the platform description that’s no longer accurate is omitted, according to the company.

Thirty Madison starts off the presentation by introducing its mission, which is to run a healthcare company that’s designed around patients, not doctors and bills.



Thirty Madison


The company points out the giant chronic-care market and hints at what might be its next treatment area: cholesterol, hypertension, or COPD.



Thirty Madison


The startup connects patients with doctors who can then create treatment plans.



Thirty Madison


A lot of chronic-care patients can’t find or afford the treatment they need in the traditional healthcare system. There are too few migraine specialists given the roughly 40 million patients in the US, according to the Migraine Research Foundation, and wait times for dermatology can range from 10 to 78 days, depending on the city, according to a Merritt Hawkins survey in 2017.



Thirty Madison


Thirty Madison lays out its “care model” across hair loss, migraines, and gastrointestinal conditions like acid reflux.



Thirty Madison


Thirty Madison’s guidelines for treatment and diagnoses are developed with the help of medical advisors from institutions like Massachusetts General Hospital and Johns Hopkins.



Thirty Madison


Thirty Madison makes clear its ambitions to expand into new treatment areas. Gutentag told Business Insider that it was looking to tackle chronic issues that affect millions of patients each year.



Thirty Madison


Thirty Madison dedicates a few slides to Keeps, its platform for treating hair loss.



Thirty Madison


Daniel, a hair-loss patient, says Thirty Madison lives up to its promise.



Thirty Madison


Thirty Madison works with drug companies to get the costs of treatments down. For migraine treatments, it works with specialists to design protocols and collaborates with five leading pharmas to offer new treatments — including Eli Lilly’s injectable Emgality, a prescription drug that’s meant to prevent migraines before they start, for as little as a $0 copay with insurance. This slide shows the cost of hair-loss medicines.



Thirty Madison


Thirty Madison then dedicates a couple of slides to Cove, its platform for treating migraines.



Thirty Madison


Most of Cove’s patients have severe symptoms, in that they have more than nine migraines every month.



Thirty Madison


Keeps and Cove are tackling $7 billion and $16 billion markets, respectively, Thirty Madison says.



Thirty Madison


Thirty Madison told investors it was looking at a $1.5 billion revenue opportunity. Over the past year, its revenue has tripled, the company told Business Insider.



Thirty Madison


Thirty Madison is building treatment regimens one chronic condition at a time. It starts with partnering with advisors like Johns Hopkins and hiring leadership, and doesn’t launch until the platform has been tested.



Thirty Madison


The leadership squad is from Google, Amazon, McKinsey, Uber, and other high-profile shops.



Thirty Madison


The presentation closes with Thirty Madison’s logo and the promise of a “once-in-a generation opportunity” to transform healthcare.



Thirty Madison


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